{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:39:09Z","timestamp":1792060749907,"version":"4.4.0"},"reference-count":44,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"22","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["J Clin Oncol"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>The phase III CHALLENGE trial (CCTG CO.21) demonstrated that a 3-year structured exercise program (SEP) improved disease-free and overall survival versus health education materials (HEM) in patients with stage III or high-risk stage II colon cancer after surgery and adjuvant chemotherapy. We assessed the cost-effectiveness of the SEP versus HEM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This prespecified economic evaluation used prospectively collected data from all trial participants (N = 889). The base case adopted the Canadian public payer perspective and included direct health care costs over a 5-year time horizon with a 1.5% discount rate. 36-Item Short Form (SF-36) outcomes were mapped to Short-Form 6-Dimension (SF-6D) utilities using a validated algorithm. Mean costs (2024 in Canadian dollars [CAD]) and effects (life-years [LYs] and quality-adjusted LYs [QALYs]) per participant in each intervention group were used to estimate the incremental costs, incremental LYs\/QALYs, incremental cost-effectiveness ratio (ICER, $ CAD\/life-year gain [LYG]), and incremental cost-utility ratio ($ CAD\/QALY) when applicable. Uncertainty was assessed via bootstrapping (1,000 samples). Notable scenario analyses included a 10-year time horizon and a societal perspective incorporating lost wages because of missed work, measured through the Work Productivity and Activity Impairment questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In the base case, despite an up-front cost of $2,917 (CAD)\/participant to provide the SEP, the SEP strategy (total cost: $31,957 (CAD)\/participant) was dominant over HEM (total cost: $33,546 (CAD)\/participant), being less costly (-$1,589\/participant) and more effective (+0.05 LYs\/participant; +0.10 QALYs\/participant). The SEP was dominant in 53% of bootstrap samples, and 80% fell below a $50,000 (CAD) per QALY willingness-to-pay threshold. Major cost drivers were cancer recurrence or new malignancy and anticancer therapy. Scenario analyses were consistent with the base case.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>The SEP was less costly and more effective than HEM. This study can inform payers and health systems with implementation of SEPs in routine care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco-26-00765","type":"journal-article","created":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T12:00:21Z","timestamp":1780228821000},"page":"2130-2139","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":2,"title":["Structured Exercise Program After Adjuvant Chemotherapy for Colon Cancer: A Cost-Utility Analysis of the CHALLENGE Trial"],"prefix":"10.1200","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2501-3057","authenticated-orcid":false,"given":"Kelvin K.W.","family":"Chan","sequence":"first","affiliation":[{"name":"Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, 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